1. Field of the Invention
The present invention relates to a medical apparatus including a first medical device with a bending portion which is provided in an insertion portion and which is bent by a driving force of a driving portion, and a second medical device with an external force applying portion that applies an external force to the insertion portion of the first medical device by means of the driving force of the driving portion so that the insertion portion can operate.
2. Description of the Related Art
In recent years, what is called endoscopic retrograde cholangio pancreatography (hereinafter referred to as ERCP) has been performed in which a diseased site of a canalicus, for example, a diseased site in a pancreaticobiliary system, is examined and treated using a sideward viewing endoscope with an image pickup optical system disposed on a side surface of a distal end of an insertion portion. The ERCP using the sideward viewing endoscope includes examinations in which images of a bile duct or a pancreatic duct are picked up using the endoscope, and therapeutic treatments in which gallstone present in a common bile duct or the like is recovered using a balloon or a treatment instrument.
Since the pancreatic duct and the bile duct are very thin, it is difficult to insert, for the ERCP, the distal end portion of the insertion portion of the endoscope directly into the bile duct or the pancreatic duct. Normally, an operator first inserts the distal end portion of the insertion portion of the sideward viewing endoscope until the distal end portion reaches the vicinity of a duodenal papilla. Thereafter, while observing appropriate sites through the endoscope, the operator draws out any of various endoscopic treatment instruments (hereinafter simply referred to as “treatment instruments”) such as a cannulation tube through a treatment instrument insertion tube cavity formed in the side surface of the distal end portion of the insertion portion. The operator then inserts the treatment instrument into the bile duct or the pancreatic duct.
At this time, the operator uses what is called a treatment instrument raising table provided in the vicinity of the opening at the distal end of the treatment instrument insertion tube cavity. A raising angle of the treatment instrument raising table can be varied by a manual operation. Thus, varying the raising angle of the treatment instrument raising table allows a direction in which the treatment instrument is drawn out through the opening to be varied to easily guide the treatment instrument to the bile duct or the pancreatic duct.
For example, an endoscopic device 150 shown in FIG. 1 includes a sideward viewing endoscope 100 and an endoscopic treatment instrument 110. An opening 102a is formed at a distal end portion 102 of an insertion portion 101 of the sideward viewing endoscope 100. An insertion portion 111 of the endoscopic treatment instrument 110, for example, an imaging tube, a high-frequency treatment instrument, or a balloon catheter (hereinafter referred to as the treatment instrument insertion portion in order to distinguish this insertion portion from the insertion portion 101 of the sideward viewing endoscope 100) is drawn out through the opening 102a. 
To draw out the treatment instrument insertion portion 111 through the opening 102a and then insert the treatment instrument insertion portion 111 through the bile duct, the operator performs a procedure described below.
First, the operator performs a manual operation of operating a bending knob 104 provided on an operation portion 103 to bend a bending portion (not shown in the drawings), a manual operation of twisting the insertion portion 101, and the like. Thus, the distal end portion 102 is placed opposite a target site, for example, a duodenal papilla 120 in a desired condition.
Then, the operator draws out the treatment instrument insertion portion 111 into a body via a treatment instrument insertion channel (not shown in the drawings) formed in the insertion portion 101 of the sideward viewing endoscope 100 and via a treatment instrument raising table (hereinafter simply referred to as a raising table) 105 located in the vicinity of the opening 102a. Since the raising table 105 has not been raised yet, the treatment instrument insertion portion 111 is thus drawn out as shown by a dashed line or an alternate long and short dash line.
The amount by which the treatment instrument insertion portion 111 is drawn out varies, for example, as shown by the dashed line and the alternate long and short dash line depending on the amount by which the treatment instrument insertion portion 111, positioned close to the operator's hands, is pushed in.
After drawing the treatment instrument insertion portion 111 into the body, the operator operates a raising table operation lever 106. Then, a raising wire (not shown in the drawings) inserted through the insertion portion 101 is pulled. An angle of the treatment instrument raising table 105 is varied in conjunction with this traction. That is, a direction in which the treatment instrument insertion portion 111 is drawn out is changed, for example, from one shown by the alternate long and short dash line to one shown by a solid line. Thus, a distal end 112 of the treatment instrument insertion portion 111 is placed opposite the duodenal papilla 120.
However, in this state, the direction in which the treatment instrument insertion portion 111 is drawn out is toward a pancreatic duct 121. Introducing the treatment instrument insertion portion 111 into a bile duct 122 is thus difficult. Consequently, the operator makes adjustment such as an operation of the bending knob 104, provided on the operation portion 103, to introduce the treatment instrument insertion portion 111 into the bile duct 122.
Thus, the operator needs to be skilled in order to perform the manual operation of placing the distal end portion 102 of the insertion portion 101 of the endoscope 100 opposite the duodenal papilla 120 and smoothly introducing the treatment instrument insertion portion 111 into the pancreatic duct 121 or the bile duct 122.
In recent years, a sideward viewing endoscope with an electric raising table has been proposed in order to improve the operator's workability. This sideward viewing endoscope is configured such that the raising wire is pulled by, for example, a driving motor provided in the operation portion. Furthermore, Japanese Patent Application Laid-Open Publication No. 7-000350 proposes a driving mechanism for a treatment instrument which rotationally drives the raising table into a raising table housing portion in the endoscope distal end portion, the driving mechanism replacing the driving motor provided in the operation portion. According to such a sideward viewing endoscope, the operator operates an inputting portion of the operation portion including switches or buttons to vary the angle of the raising table. Thus, a burden on the operator is reduced.
Also for the treatment instrument, a treatment instrument manipulator has recently been proposed in which the treatment instrument insertion portion includes a bending portion having a plurality of active joints in order to improve the operator's operability. For example, Japanese Patent Application Laid-Open Publication No. 8-224241 discloses a medical manipulator that allows a driving actuator to drive a driving wire. According to the medical manipulator, when the operator operationally tilts a joy stick, a position indicated by the joy stick is inputted to the controller. The controller converts the position into a bending angle and rotation angle of a treatment portion to drive a bending driving actuator and a rotational driving actuator. Then, the bending portion of the medical manipulator is bent to operate the treatment portion in the operator's desired direction. Thus, the operator can easily place the distal end of the treatment instrument opposite the treatment site by operating the joy stick.
As shown in FIG. 2, a sideward viewing endoscope 130 with an electric treatment instrument raising table and a medical manipulator 140 form an endoscopic device 150A. The operator's workability can be drastically improved.
In FIG. 2, reference numeral 131 denotes a raising table angle instruction inputting portion. The operator tilts the raising table angle instruction inputting portion 131, for example, in the direction of arrow a. A driving motor 107 in the operation portion 103 is then driven to pull the raising wire (not shown in the drawings) inserted through the insertion portion 101. Then, the raising table 132 is raised. On the other hand, reference numeral 141 denotes a joy stick for a bending operation provided in a treatment instrument operation portion 142. The joy stick 141 can be operationally tilted, for example, in the direction of arrow c, d, e, or f. In response to the tilting operation of the joy stick 141, driving actuators 143 and 144 in the treatment instrument operation portion 142 are driven. Then, the bending potion 113 is bent, for example, as shown by an alternate one and two short dash line to enable a position of the distal end 112 to be changed.